PubMed Health⌕ Search

Biomedical subjects

M Mansat

Publications and source records attributed to M Mansat.

At least 37 records · Page 2Linked to original sources
PubMed1997

[Value of external fixation in proximal tibial fractures].

PURPOSE OF THE STUDY: This study was a retrospective analysis of 39 proximal metaphyseal tibial fractures treated by Orthofix fixator in two trauma departments. MATERIAL AND METHOD: There were 28 men and 10 women with a mean age of 49.5 years. 13 pedestrians were stroked by a car and 18 had a traffic accident on a motorcycle. In 27 cases, the fracture was open with following Cauchoix grading: 15 types 2, 6 types 1 and 6 types 3. All fractures were partially or totally included in the proximal epiphyseal square of the AO system. 14 fractures were metaphyseal, 13 diaphyso-metaphyseal and 12 had an articular irradiation. All external fixations were performed using the Orthofix device, with image intensification. A partial weight bearing was allowed for 2.4 months as an average and full weight bearing at mean 3.7 months. 7 skin grafts, 2 micro surgical (latissimus dorsi) and 2 local flaps were necessary. RESULTS: In 3 patients this technique failed. 3 patients had an autologous bone graft at the metaphyseal and 2 at the diaphyseal fracture site. 30 patients healed without other procedure after an average delay of 5.5 months. During the healing and weight bearing time, 6 frontal deformities appeared and 5 flexion contractures were not reoperated. With a minimum follow up of one year (mean 3 years) 22 fractures had no deformity, 8 had a valgus deformity (5 degrees to 10 degrees) and 3 a varus deformity (6 to 17 degrees). For the 25 patients with an isolated proximal tibial fracture, 11 (44%) had an excellent functional result (no pain, full range knee motion, normal daily activity); 12 (48%) had a good result (episodic pain, minimally knee discomfort, flexion limitation). DISCUSSION: Orthofix fixator appear to be a good solution for comminuted fractures. These fractures have anatomical and epidemiological particularities. AO classification system is not useful; a new one is proposed. External fixator must be placed meticulously after closed fracture reduction.

Accidents, Traffic↗
PubMed1996

Anatomic study of the tendinous rotator cuff of the shoulder.

The aim of this study was a better understanding of the role of the vascular supply as a pathogenic factor in rotator cuff disease. Twenty-five shoulders from unembalmed cadavers were studied after injection of the upper limb aa. with barium sulfate. The predominant arteries were the vessels of the subscapularis m. These branches originated from the axillary a. the anterior circumflex humeral a., and the posterior circumflex humeral a. The supraspinatus m. was supplied by the suprascapular a. but the acromial branch of the thoracoacromial a. supplied the tendon of the supraspinatus. The infraspinatus and teres minor tendons were vascularised by the ascending branches of the posterior circumflex humeral a. The tendon of the long head of the biceps brachii m. was supplied by a branch termed the "arcuate artery" and by a branch we describe derived from the brachial a. at the level of the latissimus dorsi tendon and travelling in a true mesotendon. There is a very real critical zone, with a lesser blood-flow, 1.5 cm from greater tubercle, situated mainly at the supraspinatus tendon. This is a convergence zone of the anterior and posterior circumflex humeral aa., the suprahumeral a. and the thoracoacromial a. The histologic studies confirmed the poor vascularity of this critical zone.

Adult↗
PubMed1996

Kinematic MR imaging of the shoulder: normal patterns.

OBJECTIVE: We performed this study to define the normal patterns of the glenohumeral joint with kinematic MR imaging in healthy volunteers. SUBJECTS AND METHODS: Twenty healthy volunteers (39 shoulders) were studied with a 1.5-T imager. Successive fast low-angle shot images (75/11 [TR/TE], 15 degrees flip angle) were obtained in the axial plane from full internal to full external rotation at the superior, middle, and inferior glenoid levels. RESULTS: The free margin of the anterior labrum was seen to be slightly mobile and its base was always fixed. The anterior labrum showed changes in shape and signal intensity during internal rotation (54%). The posterior labrum remained motionless in 97% of patients and no shape or signal-intensity changes were noted during internal rotation. The anterior joint capsule was taut during external and internal rotation, exhibited a slack pattern in 51% of patients, and a folded pattern in 14% of patients. CONCLUSION: Kinematic MR imaging, which permits dynamic evaluation of the various anatomic components that may be involved in shoulder instability, also provides information on the labrocapsular ligamentous complex.

Adult↗
PubMed1996

[Value of intramedullary locked nailing in distal fractures of the tibia].

PURPOSE OF THE STUDY: This study is a retrospective analysis of 38 extra-articular distal tibial fractures treated by intramedullary locked nailing. PATIENTS AND METHODS: 38 patients with a distal metaphyseal extra-articular fracture (43 A AO type) or with minimal ankle joint extension were managed. There was 26 men and 12 women with a mean age of 32.3 years, 10 fractures were open. The fractures were transverse or oblique in 13 cases, with torsional or flexion wedge in 12 cases and spiroïd in 13 cases. In only 2 cases was the fibula intact. AO classification was not useful because many fractures began more proximally than the limit described by Müller. All the fractures were fixed by closed locked intramedullary nailing : the nail was cut just after the distal hole and impacted close to the subchondral plate. In 7 cases the fibula was fixed too. RESULTS: There was no postoperative complication in 27 cases. Three patients had a transient nerve palsy (one tibial nerve and two common fibular nerve). In ten cases the nail was dynamized. One patient had a non union but healed with a new dynamic nail. Two patients had a delayed union and healed after dynamization and osteotomy of the fibula. The mean time to union was 5 months (2 to 8). 8 patients had a varus or a valgus deformity of 3 to 6 degrees. 11 patients suffered from anterior knee pain and in 5 patients the fracture site was painful. In 18 patients a CT scan was performed : 6 had a rotational deformity from 4 to 26 degrees, and 2 a tibial lengthening (discrepancy of 7 and 9 mm). CONCLUSION: Closed intramedullary nailing is a safe and effective method for the treatment of distal metaphyseal tibial fractures. The authors propose a new classification.

Adolescent↗
PubMed1995

[Analgesia with intra-articular injection of buprenorphine after surgery of the shoulder].

The effect of 10 ml of intra-articular buprenorphine (0.30 mg) or normal saline on postoperative pain after shoulder surgery was studied in a randomized, prospective, double-blind study in 30 ASA I-II patients receiving general anaesthesia. The pain scores (Five Point Scale ranging from "no pain" to "unbearable pain" and Visual Analog Pain Scale) 1, 2, 3, 4, 6 and 24 hours after surgery, time to first analgesic use and total 6-hours and 24-hours analgesic requirements were recorded. VAPS was significantly lower in the buprenorphine group compared with placebo-treated patients one hour after surgery (p < 0.05). The time to first analgesic use was longer and total 6-h opioid requirements were lower in the buprenorphine group when compared with the control group (p < 0.05). No significant differences were detected in total 24-h analgesic requirements between the two groups. These results indicate that intra-articular injection of buprenorphine after shoulder surgery provides short analgesia. This effect may be mediated by systemic absorption.

Adolescent↗
PubMed1994

[Results of the surgical repair of the rotator cuff. Radio-clinical correlation].

INTRODUCTION: This study was undertaken to evaluate the functional results of rotator cuff tear repair. MATERIAL AND METHODS: This retrospective study concerned 108 shoulders operated with a minimal follow up of 1 year (mean 5.5 years). The average age of this masculine population was 55 years. The rotator cuff tear involved: 39 times the supra-spinatus, 59 times the supra-spinatus and infra-spinatus, 6 times the supra and infra-spinatus and the teres minor, 4 times the supra-spinatus and superior part of the sub-scapularis. All these patients were reviewed using the Constant's score. The functional results were compared with an ultrasonographic study and a radiographic protocol including 5 views. Muscle strength was measured objectively with the aid of an isokinetics testing (Cybex II). RESULTS: The results were satisfactory concerning pain (67 per cent did not suffer anymore) daily activity (78 per cent experienced a slight disability) and mobility (92 per cent of the patients had an anteflexion > 120 degrees and 82 per cent an external rotation > 40 degrees). Concerning strength, the results were variable and related to the posterior extension of the tear. Most of the patients complained of weakness (mean objective deficit of strength = 25 per cent), specially a disability during repetitive over head activities. The radiographic protocol analysed the humeral head position (16 per cent of spontaneous acromio-humeral interval narrowing on the standard X Ray and 43 per cent of dynamic narrowing on Leclercq view). The spontaneous narrowing was correlated with a severe omarthrosis and a re-rupture of the rotator cuff. All these re-ruptures involved an infraspinatus lesion. Dynamic narrowing, with an acromial interval < 7 mm, were seen in 71 per cent of the patients with posterior extension of the rotator cuff tear explaining the poor final result; the ultrasonographic assessment found a thinning (75 per cent of patient) and a heterogeneity in the infraspinatus even after repair. We found 14 re-ruptures and 6 ultrasonographic disorganised structures. DISCUSSION: A well preserved external rotation and a centred head gave good result because they were associated with the integrity of the infra-spinatus, essential to the muscular balance of the rotator cuff and necessary for the dynamic and static centering of the humeral head. In 71 per cent of the cases, the suture of the posterior cuff tear did not allow a good dynamic position of the humeral head. A spontaneous narrowing (static view) of the acromio-humeral interval was in relation with a re-rupture which evolved to omarthrosis. A dynamic narrowing with a Leclercq radiograph was associated with a functional deficit after rotator cuff repair. CONCLUSION: Humeral head stabilisation, supplied by posterior muscles of the rotator cuff, is essential in prevention of omarthrosis and in recovery of good strength. In several specific cases, we think that the transfer of an external rotator muscle, with a good humeral head stabilization action, may restore strength.

Acromion↗
PubMed1993

Risk factors for hip fracture. MEDOS study: results of the Toulouse Centre.

The development of preventive strategies for hip fractures requires better identification of risk factors. The MEDOS study was designed to study prospectively the incidence of hip fracture in 14 centres from six countries and characterise risk factors. At one centre (Toulouse), data were gathered from questionnaires completed by 386 cases of hip fracture aged over 50 years and 848 age- and sex-matched controls over a 12-month period. Of the 935 variables of the MEDOS questionnaire, 235, grouped into 56 items, were statistically analysed. Odds ratios (and 95% confidence intervals) were estimated for each variable from a multiple stepwise logistic regression model. The population comprised 19.2% men and 80.8% women, with a mean age of 80 +/- 8.8 years; 80% were living in an urban area and 76% with their family. Of the 17 significant variables, moderate excess weight and a high nutritional intake of calcium were associated with a decreased risk of hip fracture. Loss of autonomy, a higher height than normal (> 1SD), and a history of previous fractures significantly increased the risk of fracture. Interestingly, all these variables accounted for only 18% of the risk of hip fracture.

Aged↗
PubMed1993

[Loco-regional anesthesia and orthopedic surgery of the shoulder].

Interscalene block can induce by itself anesthesia for shoulder surgery, if the opening does not reach the delto-pectoral site nor the shoulder-blade, but medical indications must be thoroughly talked over on account of the risk of phrenic paralysis with patients suffering from breezing trouble, and the surgical position that may disturb the anesthesiologist in case he has to increase anesthesia. A superficial cervical plexus block is required in anesthesia of the upper part of the shoulder. Regional anesthesia is quite useful too as a complement to general anesthesia, for it provides excellent postsurgical analgesia. A catheter may be inserted at the end of the surgical process through a nerve stimulator, but the patient does not tolerate it long, its efficiency greatly diminishes after the first day, and paresthesias may occur as after-effects. Today we prefer set interscalene block before the patient is anaesthetized, searching for paresthesias with a thin needle: this process does not take long to install, it is relatively painless and provides excellent analgesia during the per and post-surgical period, until the next day with long acting local anesthetics. Not any complication happened in fifty patients for one year.

Cervical Plexus↗
PubMed1992

Contractures of the proximal interphalangeal joint.

Posttraumatic stiffness of proximal interphalangeal joints remains a difficult problem that severely compromises hand function. The emphasis of treatment must be on preventing the problem from developing, which begins within hours of the injury. Effective treatment involves a careful evaluation of the injury and then instituting a rational course of therapy. When surgery is necessary, the operative technique must be precise, and it requires a thorough understanding of the anatomic and pathomechanical factors that cause the contracture. Effective postoperative therapy and rehabilitation are integral parts of any surgical procedure, and they usually continue for many months.

Contracture↗
PubMed1991

[Fractures of the proximal pole of the scaphoid bone. Anatomo-clinical and therapeutic entity].

The authors present their anatomical and clinical findings concerning fractures and nonunions of the carpal scaphoid. They stress the proximal pole type I et II of the Schernberg (type C of Herbert) classification, and they suggest isolation of an anatomical entity, by the study of blood vessels, the ligament connections, and especially the pathomechanics as well as a clinical entity, by the mechanism of fracture and the surgical treatment, emphasizing the proximo-distal screwing, with excellent results. They present a series of 29 patients, with type I or II proximal fractures, either fresh or non-unions.

Adolescent↗
PubMed1991

[An unusual displacement fracture of the 1st metacarpal bone. Apropos of a case reviewed after 3 years].

An unusual fracture of the base of the first metacarpal with in contrast with Bennett's fracture displacement of the thumb and avulsion of the Abductor Pollicis Longus tendon is described after a "Rugby" trauma. Immediate repair and stabilization of the injured structures followed by specific rehabilitation, produced a satisfactory result with normal function of the thumb three years after the injury.

Adolescent↗
PubMed1991

[Bundled central medullary bone wiring. Method of choice in the treatment of fractures of the neck of the fifth metacarpal necessitating a reduction. 30 cases].

The authors present a short series of 30 displaced fractures of the neck of the fifth metacarpal. All fractures were treated by K-wire nailing according to the method described by Fourcher in 1976. The good results confirm the advantages of this technique, allowing early mobilization and rehabilitation. The poor results are due to faults in the use of the method, and the authors emphasize these technical errors.

Adolescent↗
PubMed1991

[Anterior displacement of the tibial tuberosity. An experimental biomechanical study of its effects on the femoro-patellar joint].

The anterior displacement of the tibial condyle was proposed as early as 1963 by P. Maquet as a therapeutic solution to treat femoropatellar arthritis. However, the benefits of such a procedure remain controversial. In this work, the effects of a 1. cm anterior displacement of the tibial condyle, with and without section of the patellar wings, have been studied on the knees of fresh corpses without osteoarthritis. The knees were tested in flexion from 10 to 70 degrees. The study dealt with the contact surfaces, pressures, and femoropatellar forces, which were analyzed with an original and efficient measurement system, with the Fuji Prescale Film as a sensor. This study showed that the femoropatellar contact has not been significantly modified by the displacement of the tibial condyle. We have noted only a slight decrease in the pressure after this type of surgery. These results are in contradiction with Marquet's results. In all cases, the anterior displacement of the tibial condyle with resection of both patellar wings produced the best results. These results suggest that displacing the tibial condyle anteriorly does not have the expected effects. The indication of such a surgical procedure must therefore be established only cautiously and after ruling out other therapeutic methods.

Adult↗
PubMed1990

[Chronic impingement syndrome of the shoulder].

The subacromial joint is an area which is particularly predisposed to chronic tendon deterioration. Rupture of the rotator cuff is usually the ultimate stage of a pathology that has been present for several decades. The so-called chronic impingement syndrome is generally part of a regional pathology of the shoulder, where it is associated with lesions of the biceps long head and of the acromioclavicular joint. Surgery is indicated only when a well-conducted conservative treatment has failed, in subjects with major functional handicap and after a thorough assessment of the lesions. Pre- and postoperative rehabilitation is of considerable importance as part of the overall management.

Chronic Disease↗
PubMed1989

[Experimental biomechanical study of the advancement of tibial tuberosity].

In 1963 P. Maquet suggested tibial tuberosity advancement as a therapeutic solution for patellofemoral arthrosis, but the fiability of the operation remains controversial. An advancement of the tibial tuberosity by 1.5 centimeter, with and without bilateral retinacular release, was performed on non arthrosic knees of fresh cadavers and on knees presenting medial, lateral or bipolar patellofemoral arthrosis. The joints were tested with flexion ranging from 10 to 70 degrees. The study concentrated on contact areas, pressures and patellofemoral forces analysis using an original and efficient measuring system. The pressure sensitive film used was the Fuji Prescale Film. The study showed that, on non arthrosic knees, the patellofemoral contact was not modified to any significant extent by advancing the tibial tuberosity. In cases of bipolar patellofemoral arthrosis reduced pressures were noted. On the lateral patellofemoral arthrosis experimental model, the tibial tuberosity advancement was efficient as it allowed a 50 per cent reduction in pressure at 10 to 30 degrees of flexion and a 20 per cent reduction at 40 to 50 degrees of flexion and a 20 per cent reduction at 40 to 50 degrees of flexion. In all cases, the best results were obtained from tibial tuberosity advancement associated with bilateral retinacular release. These results indicate that tibial tuberosity advancement may have beneficial effects in cases of lateral and bipolar patellofemoral arthrosis.

Adult↗